University of Iowa Health Care

Ophthalmology and Visual Sciences

Congenital Ptosis

Marcus-Gunn Jaw Winking

Marcus-Gunn jaw-winking ptosis was first described in 1883 as unilateral upper eyelid ptosis with eyelid retraction associated with activation of the pterygoid muscle (i.e. movement of the jaw) (see Figures 4 and 5). This is a congenital condition thought to be caused by pterygoid-levator synkinesis. The exact abnormal neurological pathway has yet to be described, but it is postulated that fibers of the fifth cranial nerve are responsible for either directly or indirectly innervating the levator. Electromyographic studies have reported that the impulses generating levator activation originate from the proprioceptive receptors of the pterygoid muscles, thereby linking pterygoid movement to elevation of the eyelid. The condition is almost always unilateral and affects males and females in equal proportion (Demirci 2010). There is associated superior rectus weakness in over half of cases (Beard 1976).

In evaluating a patient with what appears to be isolated unilateral ptosis, it is valuable to ask if the infant's ptosis varies with nursing or eating. This may be a clue to look carefully for this synkinetic condition.

Figures 4 and 5: This is a patient with Marcus-Gunn Jaw Winking ptosis. (Click image for higher resolution)
Figure 4: Note the ptosis of the right upper eyelid Figure 5: Note the dramatic eyelid retraction with jaw opening
Note the ptosis of the right upper eyelid Note the dramatic eyelid retraction with jaw opening

last updated: 07-20-2010

Written by
Nandini Gandhi, MD

Reviewed by
Richard C. Allen, MD

Gandhi N, Allen RC.
Congenital Ptosis. July 20, 2010; Available from: cases/114-Congenital-Ptosis.htm

Case Presentation

Clinical Course

Differential Diagnosis and Discussion

Isolated congenital ptosis

Ptosis associated with ocular and systemic abnormalities

Treatment of Ptosis

Summary and References

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